*According to the Educational Commission for Foreign Medical Graduates (ECFMG) for first time test takers

​The cost of taking the USMLE Step 2 is staggering:

For US medical students, the exam fee is $1,285 (as of December 2018). For medical students at foreign medical schools, the tests cost is higher—currently $1,535. These fees do not include costs associated with travel and lodging to take the test.

Many U.S. and IMG medical students must travel significant distances to take Step 2 CS as this exam is only offered in five U.S. cities.

Medical students typically fund these costs, including registration fees, with student loans that accrue interest adding to the total expense.

Taking American pronunciation lessons is a wise investment.

​Our American accent program will help you:

Avoid medical disputes and malpractice claims

Get the training you want and need

Pass your USMLE

Communicate clearly with colleagues and medical staff

Improve your interviewing skills

Score high on entrance tests that evaluate your English speaking pronunciation skills

You deserve to successfully reach your professional goals, regardless of your native language and accent. However, if your accent interferes with your intelligibility, and results in the patient constantly asking you to repeat yourself - to listen extra carefully to understand what you’re saying, you have problem. This could make passing the USMLE Step 2 CS less likely and negatively impact your dream of becoming a physician in the USA.

To ensure your success this article provides:

An overview of the USMLE Step 2

How to succeed at the USMLE Step 2

The option of working together and receiving specialized professional help.

The patient needs to believe that you understand what is happening to them based on what they tell you.

Already Failed the USMLE Step 2 CS? We understand how upset you feel after all you invested in your medical education.Contact Us and turn this tragedy around!​We have the expertise, American Accent software and experience to get you that passing grade.

Our goal is for you to speak clear, understandable English with confidence - so that you both pass the USMLE Step 2 CS and be seen as the physician you are meant to be.

What is the USMLE Step 2?

The United States Medical Licensing Examination (USMLE) is a demanding, multi-step process that takes place over several years during medical school. And passing it is tough.

The USMLE is a three-step exam series, with the second step divided into two tests — Step 2 Clinical Knowledge (CK) and Step 2 Clinical Skills (CS). This latter component is the only portion of the USMLE not taken on a computer. Instead, it involves 12 mock interactions with “standardized patients” — that is, individuals who receive training to act as actual patients. The goal of this part of the exam is to assess medical students’ ability to obtain histories from patients, perform physical examinations, andcommunicate findings clearly with both patients and other medical professionals.

For each encounter, you will be given 15 minutes to review patient data, obtain a history, and perform a physical exam. You will then have 10 minutes to type a note on a computer, which should include details about the patient’s history, observations from the physical examination, data interpretation, possible diagnoses in order of likelihood, and diagnostic studies you have requested.

How it is graded – and why your clear spoken word is imperative

The Step 2 CS is graded on a pass/fail basis. You are scored on three sub-components, and you must pass each one to achieve an overall passing result. It is therefore a critical hurdle on your path to becoming a physician.

You will need to communicate clearly your data and interpretation skills.

The three separate sub-components are as follows:

Communication and Interpersonal Skills (CIS)

Spoken English Proficiency (SEP)

Integrated Clinical Encounter (ICE)

Communication and Interpersonal Skills (CIS)

In this area, you are evaluated on your ability to communicate and create an understandable narrative for patients, including fostering a relationship, gathering and delivering information, helping patients make decisions, and providing emotional support.You need to perform this exercise compassionately and confidently, and within the time constraints. Your professional demeanor should be in keeping with the important “bedside manner” that doctors are expected to have with their patients.

SEP performance is assessed by the standardized patients using a global rating scale, where the rating is based upon the frequency of pronunciation or word choice errors that affect comprehension and the amount of listener effort required to understand the examiner's questions and responses, therefore minimizing the need to repeat questions or statements. You will be graded on your spoken English communication within the context of the doctor-patient encounter.

Integrated Clinical Encounter (ICE)

The overall ICE score is a combination of the results of the checklist for the physical examination that was completed by your standardized patients and ratings provided by physician-evaluators on the detailed notes you composed about those individuals you examined.

Our goal is for you to speak clear, understandable English with confidence - so that you be seen as the physician you are meant to be.

How to succeed at the USMLE Step 2

Remember you are being graded on (CIS), (SEP) and (ICE) listed above. Two of which require clear communication and English proficiency. If you are feeling daunted by this as a non-native English speaker, there are many things you can do to build up your confidence and skills.

Practice

In preparation for the exam you should PRACTICE with your fellow students, friends, and family as much as you can. Ask them for their feedback, in particular about your accent – tell them to be brutally honest, it is the only way you will know if truthfully they had a hard time understanding you or not.

Time yourself and consider video recording your performance so you can review your general manner, facial expressions, and body language in order to see if you are emotionally supporting the patient while making their treatment decisions. It also allows you to see and perhaps modify some gestures and facial expressions to give a better impression. You can also practice in front of a mirror for the same feedback.

Consider asking your professors or fellow students that you do not know, to review the recordings, and ask them if they can understand what you are saying in the video.

Avoid using big technical words or medical jargon when talking with the patient. Keep it simple. If the test patient asks “What does that mean?” then points will likely be taken off.

Limit or don’t use any words that have to be explained. If you do, explain quickly and clearly. A general rule to keep in mind is that whatever you are asking or explaining to the patient should be put it in a way that an average 5th grader would understand, but not in a condescending way.

However, when you write your report feel free to use long technical terms as much as you like. Focusing appropriately on your target audience should always be the guide used for communication. This especially applies to the USMLE Step 2 CS.

Just make sure your explanation is easy to grasp and understand.

Focus on the patient

The exam is meant to determine if you can be a doctor who is ready to work independently and confidently with patients in a medical setting. The patient needs to believe that you understand what is happening to them based on what they tell you. And you need to be able to communicate effectively their diagnosis and the treatment plan.

During the exam, it is important to remember not to seek sympathy or ask the actor/patient to bear with you. This is not the setting to explain that you feel uncomfortable or nervous speaking English, or that you have not been in the United States for long. You must seek to show empathy during the evaluation towards your test patient, not to seek empathy for yourself.

When you think negative thoughts about yourself and your performance, your anxiety will grow. When you catch yourself thinking negatively, stop yourself. Replace it with a positive thought. Shift from focusing on yourself to focusing on your patient.

In addition, when people become nervous under pressure and don’t feel confident, sometimes they speak very softly and therefore risk not being audible in the recording that they will be graded on.

Avoid speaking in a low volume, mumbling, or speaking too rapidly - which are often symptoms of feeling nervous. Your speech should sound natural - avoiding fillers like uh and umm. This will only make your speech harder to understand and distracting.

UptalkSometimes when a person doesn’t feel confident, they speak in what is called “uptalk.” This is when the word at the end of the sentence goes up in pitch, instead of down.

This results in making the person sound like they don’t know what they’re talking about and not as intelligent. You will need to record yourself to monitor if you are speaking with this “uptalk” pattern. If so, practice making the pitch of your voice go down at the end of a spoken sentence.

MumblingThis usually happens because your mouth isn’t open enough. When you’ve got partially closed teeth and lips, the syllables can't escape properly and all the sounds run together. Mumbling can also be caused by looking down, and speaking too quietly or too quickly. Keep in mind, your mouth is an instrument, and like all instruments, the more space you allow for the sound of your voice, the more resonant and clear it will be. So open your mouth wide enough when speaking.

When you are preparing for the USMLE and practicing with your volunteer patients, remember to enunciate each syllable, focusing on keeping your mouth open and your lips moving. Exaggerate the words a bit to open up your mouth. At first, speaking with a more open mouth is going to feel strange and unnatural. Mumblers are not used to having this feeling. But by regularly doing the exercises, speaking clearly will feel more natural.

In order to be audible enough to be heard, be sure to take a new breath at the beginning of every sentence. If you are saying a long sentence, stop after a thought group or when it makes sense to stop for a breath. Be sure to maintain your breath support and not speak with a softer voice towards the end of your sentence. Project your voice across the room. At the same time, you don’t want to be too loud so that your patient is pained by the volume of your voice.

When reviewing your practice USMLE performance, listen for the letters, syllables, or words that you don't pronounce clearly. Look at how wide open your mouth is. See if there is movement in your face.

Rapid SpeechMany people start to speed up their speech and in the process are harder to understand. Rapid speech rate will decrease your intelligibility significantly. One major reason people accelerate their speech is because of nervousness. As adrenaline turns to anxiety, they begin to race through their material as if they’re trying to outrun a bullet. Nervousness is ultimately you focusing on you. “Am I good enough?” “Do they like me?” “Will I pass the test?” “How am I doing?”

This is especially the case when taking the USMLE, since you have only 15 minutes to perform the exam. In order to be able to ask all the questions, many people solve the problem by speaking quickly. Don’t do this, it will only reduce your intelligibility.

Practice many different medical scenarios ahead of time so that you are best prepared with the questions you will have to ask and can use your time and words effectively. Another way to slow down your speech is to stretch out the vowels in the words and take a breath at the end of a thought group. If you are reading, stop and take a breath whenever you see a comma or period.

We can help you prepare for the USMLE Step 2 CS. Let us work together to realize the success you deserve by gaining clear understandable English and confidence.

​Our founder, Ela Britchkow, holds a graduate degree in Speech and Language Pathology, Bloomsburg University, Bloomsburg, Pennsylvania, Certification from the Institute of Language and Phonology, and the Compton P-ESL Program with specialized training for foreign and regional accent modification. She has served as a speech therapist and a communications consultant teaching medical professionals for over 25 years.

"Being a non-American speaker myself, I understand exactly what you need to be taught, to gain a perfect American accent."We can help with speech conditions and with accent reduction lessons focused on your specific language and individual needs. Both our software and one-on-one Skype sessions will show you how to clearly pronounce the English medical terms that many have a hard time understanding and ensure your success on the exam. ​Confidently speak clear understandable English and pass the USMLE Step 2.

Our accent reduction software teaches you to correctly pronounce essential vocabulary required by medical professionals. Below please find a preview of a sample of terms that we will teach you to speak clearly.

CLICK HEREto send us ​a recording of your speech - which Ela herself will analyze and provide you with professional feedback and recommendations for your unique speech needs and goals

​​Act now! This no-obligation service is being offered at no charge for a limited time only!

Speech screening results usually fall into 3 categories: if you have a mild, moderate, or severe accent that interferes with clarity and intelligibility when speaking to native English speakers. This translates to a recommendation of 1-4 private lessons for mild accents, moderate: 5-7 lessons, and severe: 8 to 15 + lessons. ​Or sometimes, none at all! Let's find out together!

​English is rapidly becoming the world's main language. In almost every country, better education and employment opportunities depend more and more on a person's ability to speak English clearly and be understood. Internationally, the American accent is best understood among other English speakers.